Care Coordination Metrics: One Can of Worms that NEEDS to be Opened

“Track who is on a care team — and share info with the patient.”

That’s just one of the summary recommendations coming from expert testimony given in a recent public hearing on how to improve care coordination through the use of health information technology. The Meaningful Use workgroup and Quality Measures workgroups are now wrestling with how to translate this recommendation into meaningful use criteria for HITECH Stages 2 and 3.

Seems like a good idea — simple, straightforward — perhaps even obvious. The EHR (electronic health record) could be a great tool for keeping care team members in the loop and on the same page about a patient’s care.

But then I thought about this for a few minutes, and the complexities started dawning. This seemingly simple recommendation — “Track who is on a care team and share info with the patient” — is the proverbial can of worms.

In contrast, first consider the process of how you might create a team at your company.  For most, this is a  reasonably well understood process.  For example, here are some of the things that you would likely do:

1. Recruit and/or designate team members
2. Establish a meeting schedule
3. Develop objectives for the team
4. Prepare an agenda for individual meetings
5. Conduct meetings.  Some meetings might be highly structured, e.g., conducting a quality improvement process
6. Agree on action items and designate accountabilities
7. Create and distribute minutes
8. etc.

No big deal, right?

Now, think about this in the context of tracking a patient care team for yourself or a loved one.  

Care coordination in health care today still works pretty much by the seat-of-the-pants method. The health care system doesn’t have a well understood process of how to create a team, who should be on the team, or what the team should do.

I came up with a slew of additional questions raised by a simple requirement of tracking who is on a care team. 

• Who decides who’s on the team? Your “medical home” physician? someone else?
• How will you know who’s designated to be on your team? How will you understand the importance and implications of this?
• Are caregivers (e.g., parents, children of elderly patients) on the team?
• How do members of the team come and go?
• What if someone who wants to be team  isn’t designated a team member? Since your health plan is paying your medical bills, wouldn’t they want to be on your team?
• What if you’re a vendor that’s helping the health plan coordinate care on behalf of patients?
• What if a team member gets designated, but doesn’t want to be on the team?
• What if someone on the team isn’t performing?
• What are expectations of team members? Are they all supposed to keep up with new information in your electronic health record? how do we prevent team members from being deluged with information?
• Would it make sense to designate sub-teams, e.g., for patients with specific chronic conditions? would this result in fragmentation?

Feeling overwhelmed yet? These questions can be worked out over time — but tracking who is on a care team and sharing this info with patients isn’t as easy as it first sounds.

FYI, here are the specific meaningful use criteria under consideration (as of October 12) by the Meaningful Use Workgroup:

Stage 2: List of care team members available for 10-20% of patients via electronic exchange 

Stage 3: Longitudinal care plan available for electronic exchange for 50% of patients with high priority health conditions

The designation of one seemingly simple care coordination measure as meaningful use criteria will have cascading implications for clinical care, IT infrastructure, and company business models.

These are important questions. This is a can of worms that NEEDS to be opened.